There is probably no other drug emergency providers administer more often than IV fluids. We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few. These patients tend to feel better, go home and no harm comes to them. However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm. In part one of this two part series, Dr. Mackenzie discusses how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.
Take away Points
1. Unnecessary IV fluid increases mortality and kidney injury in the critically ill.
2. Most patients with septic shock do not have profound volume depletion but an increase in unstressed venous volume.
3. Cardiac output can be increased with vasopressor infusions without exposing patients to the harms of IV fluid.
Recorded at the Maine Medical Center Winter Symposium in 2017
David Mackenzie, MDCM, FRCPC, FACEP
Assistant Professor of Emergency Medicine
Maine Medical Center
Tufts University School of Medicine
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3. Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure increase mortality. Crit Care Med. 2011; 39:25-65.